Provider Demographics
NPI:1457381006
Name:RIDDICK, SHUNDRIA MONIQUE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHUNDRIA
Middle Name:MONIQUE
Last Name:RIDDICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 LAURA LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-2811
Mailing Address - Country:US
Mailing Address - Phone:214-406-6269
Mailing Address - Fax:
Practice Address - Street 1:624 LAURA LN
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-2811
Practice Address - Country:US
Practice Address - Phone:214-403-6269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19720101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional